I remember someone making a joke of that and saying with a wry smile, “I practice
medicine …. Someday, I'll get it right.” I practice medicine. Like
practicing piano or playing a sport, it is a discipline, and the first step is being
present in the clinic, in the hospital, with the patient, with the family. Wherever
we are called to be, we are there for our patients to provide care and clinical expertise.

If only our work began and ended with the care of the patient. As complex as that
can be, most of us would sigh with relief if it were the sole focus of our work.

The practice of medicine takes place within a multilayered institutional structure
that requires multiple people to keep it afloat. The practice of medicine is linked
with the complex structure of billing. Billing, insurance, and related documentation
and practice guideline requirements result in multiple layers of work and processes
that overlay, complicate, and may even interfere with the care of the patient.

I remember, early in my student days, thinking that I would do rural medicine and
I would barter. My practice would be a simple exchange of needs. I later realized
how much I am an urban child and how medical oncology would not really be feasible
in a solo rural setting. And even if it were feasible, I might barter with my patient,
but the pharmaceutical company would only want a monetary exchange.

And there is billing, along with the complex and ever-changing link between documentation
and billing. There are guidelines and regulations and levels of reimbursement, all
linked to our bottom line, to how we are compensated. We rank the specialties by level
of compensation. We observe that medical students are disincentivized to pursue general
internal medicine because of the level of compensation and the level of student debt.
We are very aware of the differences in compensation among the specialties and, although
these are generally accepted, we are becoming aware of other differences in compensation
such as those of gender, international medical graduate status, and ethnicity, among
others. Aware of the importance of equity for all of us, ACP has come forward with
a statement supporting equitable compensation for comparable work.

Acknowledging the multitude of factors that impact our practice of medicine, ACP has
developed a multitude of resources to support your ability to care for patients on
a daily basis. These include resources to help you address regulatory and quality
factors that impact your practice. I want to share some of these with you, along with
links to facilitate your access. The best place to start is with the dashboard of resources at ACP's Practice Resource page.

Because we know that inclusion leads to wellness and wellness leads to quality, ACP's wellness resources may also be of interest to you.

As you review these resources, consider opportunities that may assist you in your
goals. These modules are updated regularly. Recent additions include a diabetes module
in the ACP Practice Advisor and an evaluation and management coding utilization tool
that allows for benchmarking. If you have thoughts on topics that are missing or could
be improved, or new approaches for the information, please do forward thoughts and comments to us. Your insights are deeply valued and will improve the work the College does for you.

You have on-the-ground experience, and your efficacy may be enhanced with skill-building.
Think of the College, your professional home, as being there, by your side, ready
to assist you. If you are a champion for these issues in your practice, you may consider
more formal leadership training at the ACP Leadership Academy. You may also consider joining colleagues for ACP's annual Leadership Day and addressing health policy practice issues on Capitol Hill. Many of the topics that
are discussed with legislators relate to practice.

Consider working with your Chapter Governor on health policy issues as they relate
to practice in your state. ACP's State Health Policy program can help you take action at the state level. Join the virtual Advocates for Internal Medicine Network and subscribe to the e-newsletter ACP Advocate, where every other week you can receive the latest information on health policy topics
that may impact your practice. Invite staff who are doing this work for you to your
state meetings and help inform the College on practice issues that are of greatest
interest to you.

As always, we are living in interesting times regarding the rules around the practice
of medicine. ACP is regularly working for you to monitor the pulse of this topic and
to protect your practice options. Please visit the “Where We Stand” page on our website to learn about the latest hot topics.

Thank you for the opportunity to work with you on these issues. Thank you for what
you do every day to care for patients. Thank you for making a difference in your “practice
of medicine.” I hope these resources make your life easier.

Ana María López, MD, MPH, FACP, ACP's President for 2018-2019, is
vice chair of oncology at the Sidney Kimmel Cancer Center and director at Sidney Kimmel
Medical College at Thomas Jefferson University in Philadelphia.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.